Multicenter, randomized controlled trial of long tube versus nasogastric tube with water-soluble contrast agent for adhesive small bowel obstruction

Background: There has been controversy over the use of nasogastric tube (NGT) or long tube (LT) for the non-operative treatment of adhesive small bowel obstruction (ASBO). NGT is a standard treatment in Western countries based on an old small randomized controlled trial (RCT). On the other hand, LT is a standard procedure in Eastern Asian countries. Some studies have reported that Gastrografin thorough NGT (NGT-G) is more effective treatment for SBO than NGT alone. However, there have been no comparative studies between LT and NGT-G.
Methods: In this multicenter, RCT, patients with ASBO were randomly assigned to either LT or NGT-G between July 2016 and November 2018. The primary end point was non-inferiority of NGT-G to LT for non-surgery rate.
Results: In total, 223 patients with ASBO from 11 Japanese institutions (LT group, n=111; NGT-G group, n=112) were analyzed. The non-surgery rate was 87.4% in the LT group and 91.1% in the NGT-G group, with a 3.7% [95.3% CI, -5.55- 12.91] difference between NGT-G and LT (non-inferiority P=0.00002923). Median procedure time was significantly shorter with NGT-G (1 min) than with LT (25 min; P<0.001), whereas no significant differences in mortality or hospital stay were noted between groups.
Conclusion: NGT-G is an effective alternative to LT as the first-line treatment for ASBO. (UMIN000022669)